Provider Demographics
NPI:1215073564
Name:ACCROCCO, JOHN PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:ACCROCCO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S TUTTLE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1560
Mailing Address - Country:US
Mailing Address - Phone:937-848-8882
Mailing Address - Fax:
Practice Address - Street 1:4403 STATE ROUTE 725
Practice Address - Street 2:SUITE B
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-2700
Practice Address - Country:US
Practice Address - Phone:937-848-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.004448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2513515Medicaid
OH2513515Medicaid
OHAC0791321Medicare ID - Type Unspecified